Pub Date : 2021-07-25DOI: 10.18484/2305-0047.2021.3.360
A. S. Tolstokorov, A. N. Kulikova, I. Larin
Atherosclerosis of lower-extremity arterial disease is a common pathology in diabetes mellitus, contributing to the development of ischemic and neuroischemic forms of diabetic foot syndrome. Early diagnosis of vascular lesions helps to reduce the number of cardiovascular complications, performed amputations and improves the quality of life in these patients.The review presents the current arsenal of modern comprehensive examinations of patients with diabetic foot syndrome, including clinical and functional screening, non-invasive and invasive methods of radiological diagnosis, as well as specific assessment scales and new classifications that allow detailing and systematizing trophic foot changes with the ability to predict the course of the pathological processoccurring at sites. The using of open revascularization methods helps to achieve the healing of diabetic ulcers in a large percentage of cases, but the point is the problems associated with the localization of the lesion, the choice of conduit for bypass surgery and technical aspects significantly limit the possibilities of this treatment method. Recent technological advances in the development of endovascular surgery have expanded the indications for successful revascularization. The article highlights the results of shunting and endovascular methods in the treatment of atherosclerotic process in infrainguinal area in patients with diabetic foot syndrome.
{"title":"CURRENT ASPECTS OF DIAGNOSIS AND TREATMENT OF ATHEROSCLEROSIS OF THE LOWER EXTREMITIES ARTERIES IN PATIENTS WITH DIABETIC FOOT SYNDROME","authors":"A. S. Tolstokorov, A. N. Kulikova, I. Larin","doi":"10.18484/2305-0047.2021.3.360","DOIUrl":"https://doi.org/10.18484/2305-0047.2021.3.360","url":null,"abstract":"Atherosclerosis of lower-extremity arterial disease is a common pathology in diabetes mellitus, contributing to the development of ischemic and neuroischemic forms of diabetic foot syndrome. Early diagnosis of vascular lesions helps to reduce the number of cardiovascular complications, performed amputations and improves the quality of life in these patients.The review presents the current arsenal of modern comprehensive examinations of patients with diabetic foot syndrome, including clinical and functional screening, non-invasive and invasive methods of radiological diagnosis, as well as specific assessment scales and new classifications that allow detailing and systematizing trophic foot changes with the ability to predict the course of the pathological processoccurring at sites. The using of open revascularization methods helps to achieve the healing of diabetic ulcers in a large percentage of cases, but the point is the problems associated with the localization of the lesion, the choice of conduit for bypass surgery and technical aspects significantly limit the possibilities of this treatment method. Recent technological advances in the development of endovascular surgery have expanded the indications for successful revascularization. The article highlights the results of shunting and endovascular methods in the treatment of atherosclerotic process in infrainguinal area in patients with diabetic foot syndrome.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45488016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-25DOI: 10.18484/2305-0047.2021.3.334
A. Kadomtseva, P. Zarubenko, L. Loginova
Objective. To study the current Russian and foreign literature dedicated to the problem of application of organometallic compounds immobilized on drugdelivery in the treatment of purulent-inflammatory disease of the skin and soft tissues. Methods. The modern Russian and foreign literature, available in the Pubmed, Medline, Springer, Scopus, e-LIBRARY databases were reviewed according to the problems of purulent-inflammatory diseases, skin and soft tissue infections, the integrated approach to the treatment of purulent-inflammatory diseases, synthesis, immobilized organometallic compounds. Results. The observational study of the specificrecent achievements in the modification of antimicrobial biomaterials is presented. Metal ions havea broad range of antimicrobial activity (especially on proliferation and remodeling), possess by bacteriostatic and bactericidal effect, demonstrate multiple inhibitory effects against bacterial strains and havebeen proveneffectivein improvingwoundhealing in all its phases. Natural products and especially biologically active metals such as silver, copper, zinc and germanium, are believed to be an alternative for the development of perspective biomaterials with antimicrobial properties. In recent years, new approach for the production and application of therapeutic and diagnostic drugs based on the immobilization or grafting of drugsubstances on polymer carriers has been developed. At present, namely the immobilized compounds that have opened the way to the creation of prolonged-action drugs with low toxicity and allergenicity. Conclusion. Template synthesis of new organometallic drug compounds is considered to be a promising direction in the wound infection treatment, which requires further experimental and clinical study.
{"title":"THE ROLE OF IMMOBILIZED METAL-ORGANIC COMPOUNDS IN THE COMPLEX TREATMENT OF PURULENT-INFLAMMATORY DISEASE OF SKIN AND SOFT TISSUES","authors":"A. Kadomtseva, P. Zarubenko, L. Loginova","doi":"10.18484/2305-0047.2021.3.334","DOIUrl":"https://doi.org/10.18484/2305-0047.2021.3.334","url":null,"abstract":"Objective. To study the current Russian and foreign literature dedicated to the problem of application of organometallic compounds immobilized on drugdelivery in the treatment of purulent-inflammatory disease of the skin and soft tissues. Methods. The modern Russian and foreign literature, available in the Pubmed, Medline, Springer, Scopus, e-LIBRARY databases were reviewed according to the problems of purulent-inflammatory diseases, skin and soft tissue infections, the integrated approach to the treatment of purulent-inflammatory diseases, synthesis, immobilized organometallic compounds. Results. The observational study of the specificrecent achievements in the modification of antimicrobial biomaterials is presented. Metal ions havea broad range of antimicrobial activity (especially on proliferation and remodeling), possess by bacteriostatic and bactericidal effect, demonstrate multiple inhibitory effects against bacterial strains and havebeen proveneffectivein improvingwoundhealing in all its phases. Natural products and especially biologically active metals such as silver, copper, zinc and germanium, are believed to be an alternative for the development of perspective biomaterials with antimicrobial properties. In recent years, new approach for the production and application of therapeutic and diagnostic drugs based on the immobilization or grafting of drugsubstances on polymer carriers has been developed. At present, namely the immobilized compounds that have opened the way to the creation of prolonged-action drugs with low toxicity and allergenicity. Conclusion. Template synthesis of new organometallic drug compounds is considered to be a promising direction in the wound infection treatment, which requires further experimental and clinical study.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45407709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-25DOI: 10.18484/2305-0047.2021.3.311
S. Zybleva, S. Zyblev
Objective. To determine the immunological predictors of renal graft rejection in the early postoperative period. Methods. Three groups were formed out of the 197 renal graft recipients. The group PGF (n=101) was made up of patients with satisfactory primary graft function. The group PGD (n = 82) included patients with primary graft dysfunction without episodes of rejection. The group RGR (n=14) consisted of patients with primary dysfunction and renal graft rejection. On the 7th day after transplantation the early kidney graft function was assessed on the basis ofserum creatinine levels. When the serum creatinine value was lower than 300 μmol/L the function was considered to be primary, at a creatinine concentration was equal to or higher than 300 μmol/L, as well as in the case of needfor maintenance dialysis on the first week after transplantation, the state was classified as the renal graft dysfunction. In the early postoperative period, the number of LIN-HLA-DR+ dendritic cells with the LIN-HLA-DR+CD11c+CD123- and LIN-HLA-DR+CD11c-CD123+ phenotypes in the fluid from the drainage installed to the kidney graft during surgery was determined. Predictive characteristics of the mDC and pDC levels in the drainage fluid were determined to predict renal graft rejection, and diagnostic capability of this indicator were identified. Results. It has been revealed that renal graft rejection is characterized by a significant growth of the total number of dendritic cells in the drainage fluid, mainly due to myeloid ones. Predictive characteristics were determined by the level of myeloid and plasmacytoid dendritic cells in the drainage fluid. The cut-off point of the level of myeloid dendritic cells was determined at the level of 60.32%, and for plasmacytoid dendritic cells it corresponded to 39.68%. Conclusion. With the level of myeloid dendritic cells in the drainage fluid greater or equal 60.32%, and plasmacytoid cells lower or equal 39.68%, renal graft rejection is predicted with a sensitivity of 99% and 93%, respectively, and a specificity of 89% and 91%, respectively. What this paper adds The level of dendritic cells and their subpopulations in the drainage fluid in renal graft recipients has been firstly studied. It has been established that acute renal graft rejection is associated with a high concentration of the total number of dendritic cells in the drainage fluid. More over this increase occurs mainly due to myeloid dendritic cells. The determination of the level of myeloid and plasmacytoid dendritic cells in the drainage fluid can be used as a predictor of renal graft rejection.
{"title":"IMMUNOLOGICAL PREDICTORS OF RENAL GRAFT REJECTION IN THE EARLY POSTOPERATIVE PERIOD","authors":"S. Zybleva, S. Zyblev","doi":"10.18484/2305-0047.2021.3.311","DOIUrl":"https://doi.org/10.18484/2305-0047.2021.3.311","url":null,"abstract":"Objective. To determine the immunological predictors of renal graft rejection in the early postoperative period. Methods. Three groups were formed out of the 197 renal graft recipients. The group PGF (n=101) was made up of patients with satisfactory primary graft function. The group PGD (n = 82) included patients with primary graft dysfunction without episodes of rejection. The group RGR (n=14) consisted of patients with primary dysfunction and renal graft rejection. On the 7th day after transplantation the early kidney graft function was assessed on the basis ofserum creatinine levels. When the serum creatinine value was lower than 300 μmol/L the function was considered to be primary, at a creatinine concentration was equal to or higher than 300 μmol/L, as well as in the case of needfor maintenance dialysis on the first week after transplantation, the state was classified as the renal graft dysfunction. In the early postoperative period, the number of LIN-HLA-DR+ dendritic cells with the LIN-HLA-DR+CD11c+CD123- and LIN-HLA-DR+CD11c-CD123+ phenotypes in the fluid from the drainage installed to the kidney graft during surgery was determined. Predictive characteristics of the mDC and pDC levels in the drainage fluid were determined to predict renal graft rejection, and diagnostic capability of this indicator were identified. Results. It has been revealed that renal graft rejection is characterized by a significant growth of the total number of dendritic cells in the drainage fluid, mainly due to myeloid ones. Predictive characteristics were determined by the level of myeloid and plasmacytoid dendritic cells in the drainage fluid. The cut-off point of the level of myeloid dendritic cells was determined at the level of 60.32%, and for plasmacytoid dendritic cells it corresponded to 39.68%. Conclusion. With the level of myeloid dendritic cells in the drainage fluid greater or equal 60.32%, and plasmacytoid cells lower or equal 39.68%, renal graft rejection is predicted with a sensitivity of 99% and 93%, respectively, and a specificity of 89% and 91%, respectively. What this paper adds The level of dendritic cells and their subpopulations in the drainage fluid in renal graft recipients has been firstly studied. It has been established that acute renal graft rejection is associated with a high concentration of the total number of dendritic cells in the drainage fluid. More over this increase occurs mainly due to myeloid dendritic cells. The determination of the level of myeloid and plasmacytoid dendritic cells in the drainage fluid can be used as a predictor of renal graft rejection.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42751308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-25DOI: 10.18484/2305-0047.2021.3.370
A. N. Nechiporenko, N. Nechiporenko, D. M. Vasilevich, V. Basinsky, A. S. Nechiporenko, N. Gavina
The article represents the authors’ own observation of the patient with xanthogranulomatous pyelonephritis (XPN). Xanthogranulomatous pyelonephritisis a rare form ofchronic bacterial calculous pyelonephritis. Factors predisposingto thedevelopmentof xanthogranulomatous pyelonephritis include the following: the impairment of theurinary flowalong theurinarytract, type II diabetes mellitus, and chronic inflammation of the kidney. XPN is an uncommon cause of chronic pyelonephritis resulting in non-functioning kidneys and poses a preoperative diagnostic dilemma which may mimic other malignant diseases of a kidney (renal cell carcinoma, leiomyosarcoma) and acute pyelonephritis as a bacterial infection causing inflammation of the kidneys (a renal carbuncle). The patient was examined at the urology clinic of .Grodno State Medical University: general clinical blood and urine tests, ultrasound examination, X-ray computed tomography - native and with contrast enhancement, magnetic resonance imaging were performed. The patient underwent nephrectomy due to the impossibility of organ-preserving surgery - removal of a volumetric formation located at the hilum of the kidney and adjacent to the vessels. Histopathologyof the specimen wasconcludedas xanthogranulomatouspyelonephritis. The patientsunderwentMR examinations, ultrasound examination and X-ray computed tomography with contrast enhancement, but adiagnosisofxanthogranulomatous pyelonephritiswas not confirmed unequivocally. The final diagnosis is usually established only after histologic examinationof biopsy specimens of removed kidney.
{"title":"XANTHOGRANULOMATOUS PYELONEPHRITIS - A RARE FORM OF CHRONIC CALCULOUS PYELONEPHRITIS","authors":"A. N. Nechiporenko, N. Nechiporenko, D. M. Vasilevich, V. Basinsky, A. S. Nechiporenko, N. Gavina","doi":"10.18484/2305-0047.2021.3.370","DOIUrl":"https://doi.org/10.18484/2305-0047.2021.3.370","url":null,"abstract":"The article represents the authors’ own observation of the patient with xanthogranulomatous pyelonephritis (XPN). Xanthogranulomatous pyelonephritisis a rare form ofchronic bacterial calculous pyelonephritis. Factors predisposingto thedevelopmentof xanthogranulomatous pyelonephritis include the following: the impairment of theurinary flowalong theurinarytract, type II diabetes mellitus, and chronic inflammation of the kidney. XPN is an uncommon cause of chronic pyelonephritis resulting in non-functioning kidneys and poses a preoperative diagnostic dilemma which may mimic other malignant diseases of a kidney (renal cell carcinoma, leiomyosarcoma) and acute pyelonephritis as a bacterial infection causing inflammation of the kidneys (a renal carbuncle). The patient was examined at the urology clinic of .Grodno State Medical University: general clinical blood and urine tests, ultrasound examination, X-ray computed tomography - native and with contrast enhancement, magnetic resonance imaging were performed. The patient underwent nephrectomy due to the impossibility of organ-preserving surgery - removal of a volumetric formation located at the hilum of the kidney and adjacent to the vessels. Histopathologyof the specimen wasconcludedas xanthogranulomatouspyelonephritis. The patientsunderwentMR examinations, ultrasound examination and X-ray computed tomography with contrast enhancement, but adiagnosisofxanthogranulomatous pyelonephritiswas not confirmed unequivocally. The final diagnosis is usually established only after histologic examinationof biopsy specimens of removed kidney.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47109512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-25DOI: 10.18484/2305-0047.2021.3.285
A. Korotkikh, A. Babunashvili, A. Kaledin, R. Akhramovich, V. Derkach, R. Portnov, A. Sozykin
Objective. To prove the safety and efficacy of distal radial artery (DRA) puncture for endovascular interventions versus the traditional forearm radial artery (RA) puncture site by comparing immediate and long-term results. Methods. In 2017, a multicenter, open, randomized (1:1) study TENDERA (Comparison between Traditional Entry Point and Distal Puncture of Radial Artery) was started. During 2 years, 520 patients were included, mean age 63.4±10.0 years. The observation group (DRA puncture) included 271 patients, the comparison group (RA puncture) - 249 patients. The study included both stable patients and those with NSTEMI: the observation group - 39 (14.4%), the comparison group - 34 (13.7%), p=0.809. The primary endpoint is immediate (hospital) or late radial thrombosis. Secondary endpoints are: 1 - composite point, complications from the access artery; 2 - puncture parameters. Results. The average difference in the diameters of the RA and DRA was 0.3 mm and 0.4 mm, in some patients the DRA diameter corresponded to the RA or even exceeded it. The diameter of RA and DRA in men and women significantly differs, 2.65±0.44 mm and 2.36±0.36 mm (p=0.001), 2.31±0.39 mm and 2.13±0.38 mm (p=0.001). Technical success of DRA access requre the number of attempts. 94.1% - the percentage of successful cardiac catheterization performed through the distal radial artery approach, which is significantly less than via RA - 100% (p<0.001). In the observation group, significantly fewer rebleedings and rehemostasis were occured. In the long-term period, there were registered outstandingly more hematomas in the observation group at the time of discharge and after 1 week. Conclusion. Intermediate analysis of the results of the TENDERA study shows that there is no significant difference in the primary endpoint, but the number of complications in the observation group associated with the puncture markedly - hematoma more than 5 cm to the day of discharge and after 7 days. What this paper adds Intermediate results of the first multicenter open randomized (1:1) study devoted to the comparison of distal puncture of the radial artery versus the traditional entry point of puncture of the radial artery on the forearm during the endovascular interventions have been presented. A significant reduction of the number of local complications has been revealed in the group of distal puncture of the radial artery and the absence of differences according to the primary endpoint: early and late radial artery thrombosis.
{"title":"ANALYSIS OF INTERMEDIATE RESULTS OF A COMPARATIVE MULTICENTER RANDOMIZED TENDERA STUDY INVESTIGATING THE DISTAL RADIATION ACCESS","authors":"A. Korotkikh, A. Babunashvili, A. Kaledin, R. Akhramovich, V. Derkach, R. Portnov, A. Sozykin","doi":"10.18484/2305-0047.2021.3.285","DOIUrl":"https://doi.org/10.18484/2305-0047.2021.3.285","url":null,"abstract":"Objective. To prove the safety and efficacy of distal radial artery (DRA) puncture for endovascular interventions versus the traditional forearm radial artery (RA) puncture site by comparing immediate and long-term results. Methods. In 2017, a multicenter, open, randomized (1:1) study TENDERA (Comparison between Traditional Entry Point and Distal Puncture of Radial Artery) was started. During 2 years, 520 patients were included, mean age 63.4±10.0 years. The observation group (DRA puncture) included 271 patients, the comparison group (RA puncture) - 249 patients. The study included both stable patients and those with NSTEMI: the observation group - 39 (14.4%), the comparison group - 34 (13.7%), p=0.809. The primary endpoint is immediate (hospital) or late radial thrombosis. Secondary endpoints are: 1 - composite point, complications from the access artery; 2 - puncture parameters. Results. The average difference in the diameters of the RA and DRA was 0.3 mm and 0.4 mm, in some patients the DRA diameter corresponded to the RA or even exceeded it. The diameter of RA and DRA in men and women significantly differs, 2.65±0.44 mm and 2.36±0.36 mm (p=0.001), 2.31±0.39 mm and 2.13±0.38 mm (p=0.001). Technical success of DRA access requre the number of attempts. 94.1% - the percentage of successful cardiac catheterization performed through the distal radial artery approach, which is significantly less than via RA - 100% (p<0.001). In the observation group, significantly fewer rebleedings and rehemostasis were occured. In the long-term period, there were registered outstandingly more hematomas in the observation group at the time of discharge and after 1 week. Conclusion. Intermediate analysis of the results of the TENDERA study shows that there is no significant difference in the primary endpoint, but the number of complications in the observation group associated with the puncture markedly - hematoma more than 5 cm to the day of discharge and after 7 days. What this paper adds Intermediate results of the first multicenter open randomized (1:1) study devoted to the comparison of distal puncture of the radial artery versus the traditional entry point of puncture of the radial artery on the forearm during the endovascular interventions have been presented. A significant reduction of the number of local complications has been revealed in the group of distal puncture of the radial artery and the absence of differences according to the primary endpoint: early and late radial artery thrombosis.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42192806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-25DOI: 10.18484/2305-0047.2021.3.275
I. Maiborodin, S. Marchukov, V. I. Maiborodina
Objective. To study the features of scar formation and structural changes in the remaining renal parenchyma in rats after the kidney resection in various terms. Methods. A layeredclosure of midline laparotomy and the caudal part of the left kidney removal was performed in rats under general inhalation ether anesthesia in a clean operating room. The morphology of the remaining kidney part after resection was studied using light microscope in different terms. Results. Athrombusfrom blood leaking outof the cut vessels is formed on the damaged surface of the kidney immediately after the resection. This clot with the parenchyma is gradually replaced by the connective tissue along the edge of the defect with the subsequently formation of a thin connective or fibrous tissue scar. However, in many cases, the number of which in rats can reach 40%, the processes of kidney damage continue for a long time after surgery, and leading to total or subtotal nephrosclerosis. The detected cystic change in tubular structures, apparently, occurred firstly due to their intersection during the resection, clamping by a blood clot and / or compression by edema distal to the observation site. Then, the forming extensive scar again clamped the adjacent tubular structures with subsequent cystic degeneration and sclerosis. In this case, detritus formed from non-viable renal tissues is eliminated by macrophages, which can form multinucleated cells with fused cytoplasm. Conclusion. Structural changes in the nephrosclerosis progression after kidney resection consist in the gradual replacement of the all renal cortical and medullar parenchyma by the connective tissue. This is not associated with the autoimmune process, but is more likely due to both impaired urine outflow after intercut of the tubular structures at resection and/or compression by edema, inflammatory infiltrate, forming or organizing scar, and vascular disorders associated with these causes. The inflammation accompanying necrosis and sclerosis of the renal structures can become granulomatous. What this paper adds For the first time, it has been shown that the progressively enlarging scar can be formed after the kidney resection, resulting in total nephrosclerosis. Such changes develop both due to the intersection of the tubular structures during the resection and their compression by edema, inflammatory infiltrate, forming or organizing a scar, and vascular disorders due to the above-mentioned causes.
{"title":"SOME FEATURES OF THE KIDNEY SCAR FORMATION AFTER SURGERY IN THE EXPERIMENT","authors":"I. Maiborodin, S. Marchukov, V. I. Maiborodina","doi":"10.18484/2305-0047.2021.3.275","DOIUrl":"https://doi.org/10.18484/2305-0047.2021.3.275","url":null,"abstract":"Objective. To study the features of scar formation and structural changes in the remaining renal parenchyma in rats after the kidney resection in various terms. Methods. A layeredclosure of midline laparotomy and the caudal part of the left kidney removal was performed in rats under general inhalation ether anesthesia in a clean operating room. The morphology of the remaining kidney part after resection was studied using light microscope in different terms. Results. Athrombusfrom blood leaking outof the cut vessels is formed on the damaged surface of the kidney immediately after the resection. This clot with the parenchyma is gradually replaced by the connective tissue along the edge of the defect with the subsequently formation of a thin connective or fibrous tissue scar. However, in many cases, the number of which in rats can reach 40%, the processes of kidney damage continue for a long time after surgery, and leading to total or subtotal nephrosclerosis. The detected cystic change in tubular structures, apparently, occurred firstly due to their intersection during the resection, clamping by a blood clot and / or compression by edema distal to the observation site. Then, the forming extensive scar again clamped the adjacent tubular structures with subsequent cystic degeneration and sclerosis. In this case, detritus formed from non-viable renal tissues is eliminated by macrophages, which can form multinucleated cells with fused cytoplasm. Conclusion. Structural changes in the nephrosclerosis progression after kidney resection consist in the gradual replacement of the all renal cortical and medullar parenchyma by the connective tissue. This is not associated with the autoimmune process, but is more likely due to both impaired urine outflow after intercut of the tubular structures at resection and/or compression by edema, inflammatory infiltrate, forming or organizing scar, and vascular disorders associated with these causes. The inflammation accompanying necrosis and sclerosis of the renal structures can become granulomatous. What this paper adds For the first time, it has been shown that the progressively enlarging scar can be formed after the kidney resection, resulting in total nephrosclerosis. Such changes develop both due to the intersection of the tubular structures during the resection and their compression by edema, inflammatory infiltrate, forming or organizing a scar, and vascular disorders due to the above-mentioned causes.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44448047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-25DOI: 10.18484/2305-0047.2021.3.347
R. Komarov, A. Ismailbaev, P. Frolov, B. Tlisov
Reconstructive valve-sparing procedures on the aortic valve are one of the most dynamically developing directions in the cardiac surgery. Today cardiac surgeons all over the world prefer the aortic valve sparingoperation using autologous tissues instead biological and mechanical prosthetics. The Ross, Yakub, David, Ozaki procedures have proved their effectives, and their indicators of long-term freedom from reoperations are not inferior to classical prosthetics. In this review the authors describe the key points of the native aortic valve reconstruction. Especially, from the surgical point of view the issues of anatomy of the aortic root and the determination of the optimal «patients» for the valve-sparing procedure are discussed. The principles of reconstruction of various variants of valve development, such as uni-, bi-, three-, and quadricuspid valve anatomy, are presented in details. The approaches to aortic valve repair are described step by step, including a description of the aortic root exposure technique, options for correcting prolapse, eliminating fenestration, and annuloplasty. The evaluation of literature data showed that the overall risks of aortic valve repair in isolation or as a component of a combined intervention are nothigher than in patients with biological or mechanical prosthetics. The violation of the orientation of the commissures, the use of a pericardialcatheter, long-term prolapse, as well as expansion of the annulus fibrous are considred as an independent risk factors of significant regurgitation and reoperations in the long term after reconstruction.
{"title":"AN AORTIC VALVE-SPARING OPERATION: INDICATIONS, TECHNICAL ASPECTS AND RESULTS","authors":"R. Komarov, A. Ismailbaev, P. Frolov, B. Tlisov","doi":"10.18484/2305-0047.2021.3.347","DOIUrl":"https://doi.org/10.18484/2305-0047.2021.3.347","url":null,"abstract":"Reconstructive valve-sparing procedures on the aortic valve are one of the most dynamically developing directions in the cardiac surgery. Today cardiac surgeons all over the world prefer the aortic valve sparingoperation using autologous tissues instead biological and mechanical prosthetics. The Ross, Yakub, David, Ozaki procedures have proved their effectives, and their indicators of long-term freedom from reoperations are not inferior to classical prosthetics. In this review the authors describe the key points of the native aortic valve reconstruction. Especially, from the surgical point of view the issues of anatomy of the aortic root and the determination of the optimal «patients» for the valve-sparing procedure are discussed. The principles of reconstruction of various variants of valve development, such as uni-, bi-, three-, and quadricuspid valve anatomy, are presented in details. The approaches to aortic valve repair are described step by step, including a description of the aortic root exposure technique, options for correcting prolapse, eliminating fenestration, and annuloplasty. The evaluation of literature data showed that the overall risks of aortic valve repair in isolation or as a component of a combined intervention are nothigher than in patients with biological or mechanical prosthetics. The violation of the orientation of the commissures, the use of a pericardialcatheter, long-term prolapse, as well as expansion of the annulus fibrous are considred as an independent risk factors of significant regurgitation and reoperations in the long term after reconstruction.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45524195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-25DOI: 10.18484/2305-0047.2021.3.382
S. E. Gryaznov, G. Melkonyan, A. Shulutko, V. Semikov, E. Osmanov, E. Gandybina
Objective. To present the results of the author’s own series of transoral operations in patients with pathology of the thyroid and parathyroid glands. Methods. Transoral surgery was performed in women (n=20) and (n=1) man. All patients were operated on for the primary disease and met the selection criteria based on ultrasound and cytological examinations, hormonal levels, and somatic status. Indications for surgery were: nodular goiter in 17 cases, diffuse toxic goiter - in 2 cases, parathyroid adenoma - in 2 cases. The surgical technique included a three-port approach in the lower fornix of the vestibule of the mouth and a gas technique for maintaining the working cavity. Standard laparoscopic instruments and an energy based ultrasonic device were used for the operation. In the postoperative period, patients underwent a test for subjective assessment of the aesthetic result of the operation using the survey of thedermatology life quality index. Results. Thyroidectomy was performed in 4 patients, hemithyroidectomy - in 15 patients and parathyroidectomy - in 2 patients. In one patient, transoralparathyroidectomy was performed as a part of a simultaneous operation for multiple endocrine neoplasia type 1 syndrome. Papillary cancer T1N0M0 was verified in two patients after surgery. The mean operation time was 196.1 min (range 110 - 300 min). Average blood loss - 3 9.5 ml (range 10 - 300 ml). The nineth operation required the conversion due to severebleeding. In one case, the temporary recurrent laryngeal nerve(RLN)injury was reported, in one case - hematoma. After surgery, the median and average values of thedermatology life quality index were 1 (IQR 0-4) and 2.05, respectively, which indicates an insignificant effect on the quality of life. Conclusion. Transoral endoscopic surgery on the thyroid and parathyroid glands would be thepromising optimal choice in patients to avoid scarring on the neck.
{"title":"TRANSORAL THYROIDECTOMY AND PARATHYROIDECTOMY: SERIES OF CASES","authors":"S. E. Gryaznov, G. Melkonyan, A. Shulutko, V. Semikov, E. Osmanov, E. Gandybina","doi":"10.18484/2305-0047.2021.3.382","DOIUrl":"https://doi.org/10.18484/2305-0047.2021.3.382","url":null,"abstract":"Objective. To present the results of the author’s own series of transoral operations in patients with pathology of the thyroid and parathyroid glands. Methods. Transoral surgery was performed in women (n=20) and (n=1) man. All patients were operated on for the primary disease and met the selection criteria based on ultrasound and cytological examinations, hormonal levels, and somatic status. Indications for surgery were: nodular goiter in 17 cases, diffuse toxic goiter - in 2 cases, parathyroid adenoma - in 2 cases. The surgical technique included a three-port approach in the lower fornix of the vestibule of the mouth and a gas technique for maintaining the working cavity. Standard laparoscopic instruments and an energy based ultrasonic device were used for the operation. In the postoperative period, patients underwent a test for subjective assessment of the aesthetic result of the operation using the survey of thedermatology life quality index. Results. Thyroidectomy was performed in 4 patients, hemithyroidectomy - in 15 patients and parathyroidectomy - in 2 patients. In one patient, transoralparathyroidectomy was performed as a part of a simultaneous operation for multiple endocrine neoplasia type 1 syndrome. Papillary cancer T1N0M0 was verified in two patients after surgery. The mean operation time was 196.1 min (range 110 - 300 min). Average blood loss - 3 9.5 ml (range 10 - 300 ml). The nineth operation required the conversion due to severebleeding. In one case, the temporary recurrent laryngeal nerve(RLN)injury was reported, in one case - hematoma. After surgery, the median and average values of thedermatology life quality index were 1 (IQR 0-4) and 2.05, respectively, which indicates an insignificant effect on the quality of life. Conclusion. Transoral endoscopic surgery on the thyroid and parathyroid glands would be thepromising optimal choice in patients to avoid scarring on the neck.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44902803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-25DOI: 10.18484/2305-0047.2021.3.296
V. Rybalchenko, A. Pereyaslov, I. Rybalchenko, O. Nykyforuk
Objective. To analyze the treatment results of patients with infantile hemangiomas using various methods. Methods. The study is grounded on the treatment results of children (n=189) with infantile hemangiomas during the period of 2000-2018 years. All patients were divided into the groups: 1) dynamic observation - 23 (12.2%) children; 2) local destruction - 78 (41.3%); 3) surgical treatment - 22 (11.6%); 4) drug therapy - 66 (34.9%) patients. The interstitial coagulation (n=28) and electrocoagulation of hemangioma (n=50) were applied for the local destruction. 18 patients underwent the complete removal of hemangioma and 4 - segmental resection of tumor with the subsequent propranolol treatment. Propranolol was used for the drug treatment and it was combined with the topical application of timolol (n=13). Results. Hemangioma regression was registered in 18 (78.3%) patients of the first group. Among the patients of the second group, involution of hemangioma was observed in 26 (92.6%) patients when the interstitial coagulation was applied and 2 (7.4%) children had hemangioma recurrence. A strongpositiveeffect can be reached by electrocoagulation of superficial hemangiomas (all patients). With primary radical intervention, complete cure was noted in all children, and with segmental resection only one (4.5%) child had a relapse. Keloid scars were formed in 3 (13.6%) children after surgery. Propranolol seemed to be effective in treating hemangiomasinchildrenof all ages, and in 41 (62.1%) patients hemangiomas completely disappeared. Conclusion. Before initiatingtherapy, thechildrenneed to be assessed for the contraindications and the treatment strategy.In case of infantile hemangioma should be individual based on the results of clinical investigation. Systemic propranolol treatment has gained rapid popularity as the treatment of choice for infantile hemangiomas and may be applied not only as the basic treatment, but also in combination with other methods. Surgical removal of hemangioma remains one of the common treatments components for children with infantile hemangiomas. What this paper adds Different variants of infantile hemangioma treatment have been analyzed: ranging from dynamic observation to surgical and systemic treatment. It has been shown, that in case of infantile hemangiomas, Beta-blockers have become the treatment of choice in case of the absence of contraindications; and surgical treatment is indicated in children with the risk of complications development.
{"title":"STRATEGY AND EXPERIENCE OF INFANTILE HEMANGIOMA TREATMENT","authors":"V. Rybalchenko, A. Pereyaslov, I. Rybalchenko, O. Nykyforuk","doi":"10.18484/2305-0047.2021.3.296","DOIUrl":"https://doi.org/10.18484/2305-0047.2021.3.296","url":null,"abstract":"Objective. To analyze the treatment results of patients with infantile hemangiomas using various methods. Methods. The study is grounded on the treatment results of children (n=189) with infantile hemangiomas during the period of 2000-2018 years. All patients were divided into the groups: 1) dynamic observation - 23 (12.2%) children; 2) local destruction - 78 (41.3%); 3) surgical treatment - 22 (11.6%); 4) drug therapy - 66 (34.9%) patients. The interstitial coagulation (n=28) and electrocoagulation of hemangioma (n=50) were applied for the local destruction. 18 patients underwent the complete removal of hemangioma and 4 - segmental resection of tumor with the subsequent propranolol treatment. Propranolol was used for the drug treatment and it was combined with the topical application of timolol (n=13). Results. Hemangioma regression was registered in 18 (78.3%) patients of the first group. Among the patients of the second group, involution of hemangioma was observed in 26 (92.6%) patients when the interstitial coagulation was applied and 2 (7.4%) children had hemangioma recurrence. A strongpositiveeffect can be reached by electrocoagulation of superficial hemangiomas (all patients). With primary radical intervention, complete cure was noted in all children, and with segmental resection only one (4.5%) child had a relapse. Keloid scars were formed in 3 (13.6%) children after surgery. Propranolol seemed to be effective in treating hemangiomasinchildrenof all ages, and in 41 (62.1%) patients hemangiomas completely disappeared. Conclusion. Before initiatingtherapy, thechildrenneed to be assessed for the contraindications and the treatment strategy.In case of infantile hemangioma should be individual based on the results of clinical investigation. Systemic propranolol treatment has gained rapid popularity as the treatment of choice for infantile hemangiomas and may be applied not only as the basic treatment, but also in combination with other methods. Surgical removal of hemangioma remains one of the common treatments components for children with infantile hemangiomas. What this paper adds Different variants of infantile hemangioma treatment have been analyzed: ranging from dynamic observation to surgical and systemic treatment. It has been shown, that in case of infantile hemangiomas, Beta-blockers have become the treatment of choice in case of the absence of contraindications; and surgical treatment is indicated in children with the risk of complications development.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44852423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-25DOI: 10.18484/2305-0047.2021.3.326
S. Volkov, S. Lobanov, B.S. Erdineyeva, A. A. Dutova
Objective. To determine the composition of the the parietal microflora of the colon under the condition of a tumor process and to assess the possibility of using these data from this study in the diagnosis of the colon cancer. Methods. The main group included patients (n=75) operated on in the Trans-Baikal Regional Oncology Center for the colon cancer. Among them are 38 men and 37 women aged 20 to 75 years. Control group consisted of 25 patients. The material of the main group, biopsies of tumor tissue and visually unchanged colon mucosa was taken intraoperatively during tumor removal. In patients of the control group, the material was taken during the colonoscopy. process. The detection of Helicobacter pylori in the biopsy of the mucous membrane was carried out by determining the urease activity, as well as by the method of polymerase chain reaction. The composition of the intestinal microbiota was determined by the bacteriological method. Results. As a result of comparison of the colon microbiota of the cancer patients and the control group, statistically significant differences in the quantitative composition of Lactobacillus spp., Bifidobacterium spp., Bacteroides spp., Clostridium spp., Enterococcus spp., E. coli (typical), E. coli (lactose-negative), Enterobacteriaceae, Staphylococcus spp. (CNS), Candida spp. were revealed. Moreover, a clear tendency of changes in the level of certain microorganisms (Bifidobacterium spp., E. coli (typical), Clostridium sp.) was detected when comparing the mucous membrane of a healthy person, unchanged mucous membrane of a patient with colorectal cancer, tumor tissue. A statistically significant dependence of the level of microorganisms on the sex of a patient, as well as the form of tumor growth, was revealed. Conclusion. Thus, a reliable correlation between the clinical and morphological characterization of the colon malignant tumor and the composition of the intestinal microbiota has been revealed. The microbiological features established within in the course of the study, which arise precisely under the conditions of colon cancer, can be used as an additional diagnostic marker in the diagnosis of a malignant process. What this paper adds It was found that thequantitative composition of the intestinal microbiota during the transformation into mucous and malignant tumor tissue in colon cancer and the correlation of specific microorganisms with the patient’s gender and the form of tumor growth. The state of the intestinal microbiota may represent a promising diagnostic marker for the detection of a malignant tumor.
{"title":"THE ROLE OF THE INTESTINAL MICROBIOTA IN THE COLON CANCER DIAGNOSTICS","authors":"S. Volkov, S. Lobanov, B.S. Erdineyeva, A. A. Dutova","doi":"10.18484/2305-0047.2021.3.326","DOIUrl":"https://doi.org/10.18484/2305-0047.2021.3.326","url":null,"abstract":"Objective. To determine the composition of the the parietal microflora of the colon under the condition of a tumor process and to assess the possibility of using these data from this study in the diagnosis of the colon cancer. Methods. The main group included patients (n=75) operated on in the Trans-Baikal Regional Oncology Center for the colon cancer. Among them are 38 men and 37 women aged 20 to 75 years. Control group consisted of 25 patients. The material of the main group, biopsies of tumor tissue and visually unchanged colon mucosa was taken intraoperatively during tumor removal. In patients of the control group, the material was taken during the colonoscopy. process. The detection of Helicobacter pylori in the biopsy of the mucous membrane was carried out by determining the urease activity, as well as by the method of polymerase chain reaction. The composition of the intestinal microbiota was determined by the bacteriological method. Results. As a result of comparison of the colon microbiota of the cancer patients and the control group, statistically significant differences in the quantitative composition of Lactobacillus spp., Bifidobacterium spp., Bacteroides spp., Clostridium spp., Enterococcus spp., E. coli (typical), E. coli (lactose-negative), Enterobacteriaceae, Staphylococcus spp. (CNS), Candida spp. were revealed. Moreover, a clear tendency of changes in the level of certain microorganisms (Bifidobacterium spp., E. coli (typical), Clostridium sp.) was detected when comparing the mucous membrane of a healthy person, unchanged mucous membrane of a patient with colorectal cancer, tumor tissue. A statistically significant dependence of the level of microorganisms on the sex of a patient, as well as the form of tumor growth, was revealed. Conclusion. Thus, a reliable correlation between the clinical and morphological characterization of the colon malignant tumor and the composition of the intestinal microbiota has been revealed. The microbiological features established within in the course of the study, which arise precisely under the conditions of colon cancer, can be used as an additional diagnostic marker in the diagnosis of a malignant process. What this paper adds It was found that thequantitative composition of the intestinal microbiota during the transformation into mucous and malignant tumor tissue in colon cancer and the correlation of specific microorganisms with the patient’s gender and the form of tumor growth. The state of the intestinal microbiota may represent a promising diagnostic marker for the detection of a malignant tumor.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45906070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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